1. Neonatal Abstinence Syndrome: A Family Centered Approach to Care Kelly Outlaw, M.S., CCLS

2. Objectives 1 - Attendees will learn what Neonatal Abstinence Syndrome is 2 - Attendees will identify the unique psychosocial needs of the infant and mother/caregiver 3 - Attendees will understand the challenges of working with this population 4 - Attendees will learn techniques to support the NAS infant in the NICU 5 - Attendees will identify opportunities to empower and promote infant and mother/ caregiver bonding

4. Neonatal Abstinence Syndrome (NAS) “As caregivers, our responsibility lies in doing all we can, to identify drug affected infants and to ensure that they are provided the care and protection each one deserves.”

5. What is Neonatal Abstinence Syndrome (NAS)? Neonatal Abstinence Syndrome (NAS) is a group of problems that occur in a newborn who was exposed to additive illegal or prescription drugs while in the mother’s womb. These and other drugs pass through the placenta – the organ that connects the baby to it’s mother in the womb – and reach the baby. The baby becomes addicted along with the mother.

6. Neonatal Withdrawal Symptoms CNS Disturbed sleep patterns, hyperactivity, tremors, increased muscle tone, myoclonic jerks, shrill cry, convulsions Metabolic fever, hypoglycemia, mottling, sweating, yawning, vasomotor instability Respiratory Nasal flaring, sneezing, tachypnea, hiccups Gastrointestinal Excessive sucking, poor feeding, vomiting, diarrhea

7. Common Drugs Found in NAS Babies Opiates Methadone, Oxycodone, OxyCotin, Vicodin, Heroine Psychotropic Antidepressants Stimulants Amphetamines Depressants, Sedative-hypnotics Barbiturates, Quaaludes, Tranquilizers

8. Half Life and Symptom Presentation Opiates shorter half-lives, symptoms may present within 72 hours of birth Depressants, Sedative-hypnotics longer half-lives, symptoms may present 2-4 weeks after birth

9. Signs and Tests to Diagnose NAS Finnegan score which assigns points based on each symptom and it’s severity. The infants score can help determine treatment Lipsitz Scale Toxicology of first bowel movement (meconium) Urine test (urinalysis)

10. Reporting Substance Exposed Newborns to CPS Federal law now requires under the Keeping Children and Families Safe Act of 2003 that all health care providers refer all infants identified as drug exposed to Child Protective Services. At this time fewer than half of the states have laws requiring reporting. This means that many states may not have laws requiring these infants to be reported.

11. Medical Management Babies stay in the NICU anywhere from several days to several months Babies may receive a combination of oral Morphine, Phenobarbital, Methadone, or Seizure medication Some babies who have very poor feeding may get an NG tube

12. Non Pharmalogical Management Therapeutic Handling Controlling the Babies External Environment Teaching the Parent/Caregiver Handling and Bonding techniques

13. Needs Psychosocial Infant Mother Caregiver Family Developmental Infant Mother Caregiver Family

14. Interventions the Child Life Specialist Can use in the NICU Environmental Support Therapeutic Handling Infant Massage Education on Infant Development Education on Shaken Baby Syndrome Car Seat Safety

15. Other Services Offered Prenatal Education Classes Education to Hospital Staff Pediatric unit, NICU, ER Community Education –NOPE (Narcotic Overdose Prevention and Education) –Education to Pediatricians on NAS symptoms –Education to Obstetricians

16. Challenges Faced by Healthcare Team Working With NAS Infants and Their Families

18. References Bandstra, E. S., Morrow, C. E., Mansoor, E., & Accornero, V.H. (2010). Prenatal drug exposure: infant and toddler outcomes. Journal of Addicitve Diseases, 29, 245- 258. Beachy, J.M. (2003). Premature infant massage in the NICU. Neonatal Network Journal, 22(3), 39-45. Hernandez-Reif, M., Diego, M., & Field, T. (2007). Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy. Infant Behavior & Development, 30(4), 557-561. Karp, H. (2002). The happiest baby on the block. New York, NY: Random House. McGlade, A., Ware, R., & Crawford, M. (2009). Child protection outcomes for infants of substance-using mothers: a matched-cohort study. Pediatrics, 124(1),285-293.

19. References Murphy-Oikonen, J., Brownlee, K., Montelpare, W., & Gerlach, K. (2010). The experience of NICU nurses in caring for infants with neonatal abstinence syndrome. Neonatal Network, 29(5), 307-313. Rigg, K. K., & Ibanez, G. E. (2010). Motivations for non-medical prescription drug use: a mixed methods analysis. Journal of Substance Abuse Treatment, 39, 236-247. Valez, M., & Jansson, L. M. (2008). The opioid dependent mother and newborn dyad: non-pharmacologic care. Journal of Addiction Medicine, 3, 113-120, doi:10.1097.

20. Kelly Outlaw MS, CCLS St. Joseph’s Children’s Hospital (813) 554-8509 Kelly.outlaw@baycare.org